Marlies E. A. Stouthard

The effect of adding a cognitive dimension to the EuroQol multiattribute health-status classification system

A methodological study was conducted to examine the effect of extending a frequently used simple multiattribute health-status classification system by adding a cognitive dimension. The EQ-5D questionnaire is a generic instrument to value health, developed by the EuroQol Group. The EQ-5D defines health according to five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. We defined 18 different health states according to the standard EQ-5D classification. A second set of health states was constructed similar to the first, except for the addition of a cognitive dimension (EQ-5D+C). Valuations of both sets of health states were statistically analyzed to detect the effect of the additional dimension. The cognitive dimension generated systematically different values compared with the standard EQ-5D version, whereas the content validity improved. Both systems evoked equally reliable values. Analyses showed that a simple additive model to predict summary values for health states was not optimal for both systems. Although there is a current lack of consensus regarding the domains that are selected to represent health status, this study has shown the importance of considering the inclusion of a cognitive domain.

Assessment of dental anxiety: A facet approach

Abstract Dental anxiety is a complicated phenomenon, and its multicomponent nature is often not acknowledged in existing measurement instruments. Using a facet design, a new Dental Anxiety Inventory (DAI) was constructed. Facets chosen were: time (made up of four elements: at home, on your way to the denstist, in the denstists waiting room, in the dental chair), situation (three elements: introductory aspects, dentist-patient interaction, actual dental treatment), and reaction (three elements: subjective feelings, physical reactions, cognitive reactions). Psychometric qualities of the DAI are good. The internal structure of the DAI was studied by linear and nonlinear techniques, and was partially recovered from the data. The construct and criterion validity of the DAI was supported in several studies.

A study on the convergent and discriminant validity of the Dental Anxiety Inventory

A correlational design was used to assess the convergent and discriminant validity of the Dental Anxiety Inventory (DAI), a newly developed measurement instrument designed to circumvent shortcomings of other dental anxiety questionnaires. Convergent validity was supported by a high correlation between the DAI and Corahs Dental Anxiety Scale. Discriminant validity was supported by small positive correlations with scales for neuroticism, anxiety, and fear, and nonsignificant correlations with other variables such as extroversion. The results support the construct validity of the DAI.

How Disturbing Is It to Be Approached for a Genetic Cascade Screening Programme for Familial Hypercholesterolaemia

Objectives: To assess the screenees’ views on, and the psychological impact of, a family-based genetic screening programme for familial hypercholesterolaemia (FH) and to evaluate non-participation. Methods: Self-administered questionnaires were filled out at the time of screening and after communication of the test result. Non-participants were interviewed by phone. Results: Of the people approached for screening, 2% did not participate. These 2% were not interested, had already been clinically diagnosed, or were afraid of insurance consequences. 677 screenees participated, of whom 215 (32%) tested FH positive. Less than 5% of the screenees were critical of the approach and the information provided. 20% of the screenees expressed feelings of social pressure. Effects on mood were minimal to absent, as were general ‘quality of life’ effects. Conclusions: Screening for FH is highly acceptable to screenees, although social pressure is prevalent. Only a small percentage of people being approached did not participate.

Future-Time Perspective: Analysis of a Facet-Designed Questionnaire

Summary: Future-time perspective for adolescents and young adults is directed towards several objects and may extend into the far or the near future. Differences in this perspective can affect moti...

Has the burden of depression been overestimated

OBJECTIVE To investigate whether high estimates of the burden of depression could be attributed to an overestimation of disability weights (reflecting more severe disability). METHODS We derived disability weights that were tailored to prevalence data. Empirical disability data from a Dutch community survey was used to describe three classes of severity of depression and their proportional prevalence. We obtained valuations from experts for each class and calculated the overall disability weight for depression. FINDINGS Expert valuations were similar to those of previous studies. The overall disability weight for depression was similar to other studies except the 1994 Dutch Burden of Disease Calculation, which it exceeded by 73%. The lower Dutch 1994 disability weight resulted from an overestimation of the proportion of mild cases of depression by experts (60% versus 27% observed in the empirical data used in the present study). CONCLUSION This study found no indication that disability associated with depression was overestimated. The Dutch example showed the importance of tailoring disability weights to epidemiological data on prevalence.

Follow up after a family based genetic screening programme for familial hypercholesterolaemia: is screening alone enough?

Familial hypercholesterolaemia is an autosomal dominant disorder of lipoprotein metabolism, with an estimated frequency of 1 in 500 in Western countries; it results in excess mortality from coronary artery disease.1 Now that the genetic defects can be detected and statins are available to lower lipids effectively, genetic screening has been considered.2–3 In 1994 a family based genetic screening programme for familial hypercholesterolaemia started in the Netherlands. The programmes effectiveness rests on the evidence based treatment of newly identified patients. We therefore assessed the subsequent preventive care and short term clinical outcome in people testing positive for familial hypercholesterolaemia as a proxy for the expected long term level of coronary artery disease.4 The foundation for tracing hereditary hypercholesterolaemia performs cascade screening in families of patients with clinically diagnosed familial hypercholesterolaemia with a known mutation, actively …

Two short instruments measuring quality of life in survivors of a myocardial infarction

Summary: The aim of this study was to validate the use of short, generic, quality-of-life (QoL) questionnaires in a population of myocardial infarction survivors. The feasibility, reliability, and validity of two short questionnaires (the MOS-24 and the COOP/WONCA charts) were evaluated and compared with a long questionnaire (the Sickness Impact Profile). The study population consisted of 99 myocardial infarction survivors some years after the event and 101 referents without a history of heart or brain infarction. The feasibility of the short questionnaires was good. Both instruments covered the most important domains of QoL, similar to the Sickness Impact Profile. In addition, the two short questionnaires measured “pain” and the MOS-24 also covered “vitality.” The MOS-24 had a smaller floor effect than the COOP/WONCA charts. The MOS-24 was shown to be a reliable test. Both short instruments were able to detect between-group differences (especially MOS-24) although at different rates. Convergent validity ...

Robustness of the Photo Anxiety Questionnaire: changing the sequence of stimuli and photographs.

In a split-ballot experiment (N = 458) we tested, first, to what extent the logical presentation of the Photo Anxiety Questionnaire forces respondents into the usual response pattern, that is, a higher reported anxiety on items mentioning a time closer to dental treatment. Secondly, we tested whether subjects use the nonverbal response scale or merely use the position of the photographs on the scale when answering the questions. The original questionnaire had the highest reliability and was least influenced by response bias. Changing the order of the photographs on the response scale did not alter the response pattern, implying that subjects do react to the intensity displayed in the photographs and not just to the position of the photograph on the scale. Because changing the order of the items altered the response pattern only marginally, the response pattern usually found does not seem to be the direct consequence of the logical presentation of the Photo Anxiety Questionnaire.

The use of photographs of facial expressions as a response scale

The response scale of the Photo Anxiety Questionnaire (PAQ) is nonverbal and is composed of five photographs of a face showing an expression of anxiety. To test if subjects can discriminate accurately between these photographs, a pairwise comparison experiment was conducted with 488 subjects. The results of this experiment warrant the use of the photographs as a response scale. The subjects accurately discriminated between the photographs and ranked the photographs from relaxed to very anxious, as predicted. The agreement between the subjects is not very satisfactory, but this could be less a problem when using the PAQ, as the PAQ photographs are presented in ascending order of anxiety level. Because the female photographs were judged to be more anxious than the equivalent male photographs and the results of the female photographs were more satisfactory, we suggest that only female photographs be used with both male and female respondents.